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Next Tuesday I go to the hospital for a coronary catheterization. Below is a report from the Times on a protocol developed by Peter Pronovost, MD:

The intensive care units at nearly every hospital in Michigan participated — 103 I.C.U.’s. What they had to do was use a five-point checklist to prevent infection when inserting the catheters. The steps were: Wash hands. Cover the patient with sterile drapes. Clean the skin with chlorhexidine antiseptic. Do not insert catheters into the groin area. Remove catheters as soon as they are no longer needed*….“Within 3 months after implementation, the median rate of infection was 0, a rate sustained throughout the remaining 15 months of follow-up. All types of participating hospitals realized a similar improvement.”

For decades any “serious” approach to medical spending has had to cope with various tangled economic/technological/moral realities. This is a different kind of “market” from almost any other, as David Goldhill so vividly described in our magazine. You can shop around for houses or used cars, but you don’t have the same kind of comparison-shopping opportunities when you go to the emergency room or when a doctor recommends one drug versus another. Technology has the opposite effect on medical costs from many other parts of the economy: more and more miracles become available, but at higher and higher cost. And the “insurance” aspect of our current system is skewed in many ways: You can pay fire insurance year after year and never have a fire, whereas all of us are going to die, and the great majority of us will require expensive treatment at some point before we do. “Insurance” therefore is a matter both of spreading risks across a general population, as with fire insurance; but also of spreading risks across the stages of each person’s life cycle, from the lower-cost early years to the higher-cost later ones. This creates markets forces and distortions unique to the health-care world.